Study: Depression is largely prevalent, but undiagnosed in SLE

Researchers in Pakistan surveyed 40 people with SLE using PHQ-9 scale

Patricia Inacio, PhD avatar

by Patricia Inacio, PhD |

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Depression is highly prevalent among people with systemic lupus erythematosus (SLE), but often goes undiagnosed, according to a single center study in Pakistan.

The “treatment of depression is a vital component in the management of these patients and should be offered where appropriate,” the researchers wrote in “Undiagnosed Depression and Its Effects on Patients With Systemic Lupus Erythematosus,” which also found the intensity of depression was associated with SLE disease activity and severity. The study was published in Cureus. SLE is the most common form of lupus.

People with lupus are at a higher risk of developing mental health problems, such as anxiety and depression. Early detection of these problems is central to prevent patients’ mental health from worsening.

The link between lupus disease activity and anxiety and depression still yields conflicting results, leading researchers to perform a cross-sectional study at the Fatima Memorial Hospital (FMH), in Lahore, Pakistan, from November 2022 to February 2023. A cross-sectional study looks at data at a single point in time.

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Prevalence of depression with lupus

Forty patients diagnosed with SLE, but who had no history of depression or anxiety, completed a survey that asked them to gauge their degree of mental illness and SLE disease activity, along with socio-demographic information. The Patient Health Questionnaire 9 (PHQ-9) scale, which is used to diagnose severe depressive disorder, was used to evaluate patients’ depression levels.

The patients had a mean age of 32.25 and most (92.5%) were women. All were taking hydroxychloroquine and 16 (40%) were taking mycophenolate mofetil, 15 (37.5%) azathioprine, and three (7.5%) methotrexate. Most (72.5%) were on a maintenance dose of prednisolone.

More than half (65%) had severe disease. From these, 61.5% had lupus nephritis, a serious SLE complication that can cause kidney failure, and 26.9% had multi-organ involvement. Blood vessel inflammation (vasculitis) was detected in 7.6% and muscle inflammation (myositis) in 3.8%.

The patients overall had a mean PHQ-9 score of 12.45, which is consistent with moderate depression. All but two had some degree of depression: 20% were considered to have mild depression, while moderate and severe depression were each seen in 37.5% of patients. A statistical analysis also revealed a strong positive correlation between SLE disease severity and depression.

“Our research indicates that the majority of patients had undiagnosed depression and there was a positive correlation between disease activity and the intensity of depression,” the researchers wrote.